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The online version of this article (https://doi.org/10.1186/s13047-017-0241-2) contains supplementary material, which is available to authorized users.
There is limited evidence for defining what specific method or methods should be used to clinically influence clinical decision making for forefoot neuroma. The aim of this study was to develop a clinical assessment protocol that has agreed expert consensus for the clinical diagnosis of forefoot neuroma.
A four-round Delphi consensus study was completed with 16 expert health professionals from either a clinical or clinical academic background, following completion of a structured literature review. Clinical experience ranged from 5 to 34 years (mean: 19.5 years). Consensus was sought on the optimal methods to achieve the clinical diagnosis of forefoot neuroma. Round 1 sought individual input with an open ended question. This developed a list of recommendations. Round 2 and 3 asked the participants to accept or reject each of the recommendations in the list in relation to the question: “What is the best way to clinically diagnose neuroma in the forefoot?” Votes that were equal to or greater than 60% were accepted into the next round; participant’s votes equal to or less then 20% were excluded. The remaining participant’s votes between 20 to 60% were accepted and placed into the following round for voting. Round 4 asked the participants to rank the list of recommendations according to the strength of recommendation they would give in relation to the question: “What is the best way to clinically diagnose neuroma in the forefoot?” The recruitment and Delphi rounds were conducted through email.
In round 1, the 16 participants identified 68 recommendations for the clinical diagnosis of forefoot neuroma. In round 2, 27 recommendations were accepted, 11 recommendations were rejected and 30 recommendations were assigned to be re-voted on. In round 3, 36 recommendations were accepted, 22 recommendations were rejected and 11 recommendations were assigned to be re-voted on. In round 4, 21 recommendations were selected by the participants to form the expert derived clinical assessment protocol for the clinical diagnosis of forefoot neuroma. From these 21 recommendations, a set of themes were established: location of pain, non weight bearing sensation, weight bearing sensation, observations, tests and imaging.
Following the identification of 21 method recommendations, a core set of clinical diagnostic methods have been prepared as a clinical assessment protocol for the diagnosis of forefoot neuroma. Based on expert opinion, the core set will assist clinicians in forming a clearer diagnosis of forefoot neuroma.
Additional file 1: Round 2 votes of the accepted, rejected and re-voted methods for the clinical diagnosis of forefoot neuroma. (DOCX 12 kb)13047_2017_241_MOESM1_ESM.docx
Additional file 2: Round 3 votes of the accepted, rejected and re-voted methods for the clinical diagnosis of forefoot neuroma. (DOCX 13 kb)13047_2017_241_MOESM2_ESM.docx
Vernon W. The Delphi technique: a review. International Journal of Therapy and Rehabilitation. 2009;16(2):69–76. CrossRef
Nissen, K. Plantar digital neuritis: Morton's metatarsalgia. J Bone Joint Surg. 1946:17:197–200.
Jain S, Mannan K. The diagnosis and management of Morton’s neuroma: a literature review. Foot Ankle Spec. 2016;
Bencardino J, Rosenburg Z, Beltran J, Liu X, Marty-Delfaut E. Morton's neuroma: is it always symptomatic? Am J Roentgenol. 2000;175:649–53. CrossRef
Rout R, Tedd H, Lloyd R, Ostlere S, Lavis GJ, Cooke PH, Sharp RJ. Morton’s neuroma: diagnostic accuracy, effect on treatment time and costs of direct referral to ultrasound by primary care physicians. Qual Prim Care. 2009;17(4):277–82. PubMed
Williams T, Robinson A. Entrapment neuropathies of the foot and ankle. Orthopaedics and Trauma. 2009;23(6):404–11. CrossRef
Jones R. Plantar neuralgia (metarsalgia, mortons painful affliction of the foot). The Liverpool medico-surgical. Journal. 1987:1–47.
Cabral D, Katx J, Weinblatt ME, Ting G, Avorn J, Solomon D. Development and assessment of indicators of rheumatoid arthritis severity: results of a Delphi panel. Arthritis Care Res. 2005;53(1):61–6. CrossRef
Boulkedid R, Abdul H, Loustau M, Sibony O, Alberti C. Using and reporting the Delphi method for selecting healthcare quality indicators; a systematic review. PlosOne. 2011;6:6. CrossRef
Summer. Social Research UPDATE. 2001. http://sru.soc.surrey.ac.uk/SRU33.pdf. Accessed on 24 Feb 2017.
Atkins RB. Stability of the response characteristics of a Delphi panel: application of boot strap data expansion. BMC Med Res Methodol. 2005;5:7. CrossRef
De Villers MR, De Villers PJT, Kent AP. The Delphi technique in health sciences education research. Taylor & Francis Group. 2005. http://www.tandfonline.com/doi/abs/10.1080/13611260500069947?journalCode=imte 20. Accessed 24 Nov 2015.
Morse J. The significance of saturation. 1995 http://journals.sagepub.com/doi/pdf/10.1177/104973239500500201. Accessed 12 April 2017.
Pastides P, El-Sallakh S, Charalambides C. Morton’s Neuroma: A clinical versus radiological diagnosis. J Foot Ankle Surg. 2012;18(1):22–4. CrossRef
Quinn TJ, Jacobson JA, Craig JG, van Holsbeeck MT. Sonography of Morton's neuromas. Am J Roentgenol. 2000;17(4):1723–8. CrossRef
Soo MJ, Perera SD, Payne S. The use of ultrasound in diagnosing Morton's neuroma and histological correlation. Ultrasound. 2010;18(1):14–7. CrossRef
Bosley CJ, Cairney PC. The inter metatarsal phalangeal bursa - its significance in Morton’s Metatarsalgia. J Bone Joint Surg. 1980;62(2):184–7.
Palmer L, Epler M. Fundamentals of musculoskeletal assessment techniques. Philadelphia: Williams and Wilkins; 1998.
National Health Service (NHS) Choices. Morton’s Neuroma. 2015 http://www.nhs.uk/conditions/mortonsneuroma/Pages/Introduction.aspx. Accessed 23 Feb 2017.
National Institute for Health and Care Excellence (NICE). Morton’s Neuroma. 2013. http://cks.nice.org.uk/mortons-neuroma. Accessed 11 Nov 2015.
Rowe G, Wright G. The Delphi technique as a forecasting tool: issues and analysis. Int J Forecast. 1999;15:353–75. CrossRef
Hasson F, Keeney S, McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs. 2000;32(4):1008–15. PubMed
Hassouna H, Singh D. Morton’s metatarsalgia: pathogenesis, aetiology and current management. The Belgian Society of Orthopaedics and Traumatology. 2005;71(6):646–55.
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